The overall aim of this study is to use innovative methodological approaches to estimate the role of prenatal employment in health care choices and services utilization during childbirth. Over the past 50 years in the United States, there have been profound changes in the workforce participation of pregnant women; during that same time, substantial advances in the science and technology of obstetric care have radically transformed childbirth and the available health care options related to the delivery of a baby. However, the substandard quality of maternity care is a troubling policy issue, and national attention has focused on increases in labor induction and cesarean delivery. Workforce participation may impact a pregnant woman's choices about childbirth care via health insurance and other factors related to work commitment and role conflict. The implications of employment during pregnancy for childbirth-related choices have not been well-characterized, and available research on maternal employment and health outcomes suffers known methodological limitations. The proposed project has two specific aims: 1) to improve upon the methods used to characterize impacts of prenatal employment on health outcomes and services use, and 2) to measure the impact of prenatal work on choices, quality, and patterns of childbirth care. The project will use data from a nationally-representative survey of women who gave birth in 2005 (Listening to Mothers II Survey, n=1573), which was commissioned by Childbirth Connection and conducted by Harris Interactive using rigorous sampling and data collection methodologies. The survey is distinctive in that is contains extensive and detailed information on choices and health care use in the context of childbirth as well as information on employment, which will allow us to examine the influence of prenatal work on choices around labor induction and delivery care, while also accounting for factors related to health insurance, pregnancy and medical care, and socio-demographics. This project will capitalize on a rich and unique data source and contribute to the literature by 1) improving upon prior estimation strategies by using propensity score methods to address known methodological issues, and 2) characterizing previously unexplored associations between prenatal employment and women's choices regarding childbirth care. Results from this study will provide input for future research using larger, community-based samples or administrative data as well as the development and implementation of health care and employment policies designed to facilitate better childbirth care and improved maternal and child health. Recent years have brought significant changes in the workforce participation of pregnant women and mothers. The extent to which varied employment experiences may contribute to known and growing problems with the quality of maternity care and troublesome trends in health costs and outcomes for mothers and babies is an urgent and important policy question, especially in light of current health reform efforts, stat and federal budget crises, and a national economic recession. The proposed project uses innovative methods to examine work during pregnancy as a key factor that may influence choices and health care use during childbirth, focusing on labor induction and cesarean delivery. Results from this study will provide input for the development and implementation of health care and employment policies designed to facilitate better childbirth care and improved maternal and child health. PUBLIC HEALTH RELEVANCE: Recent years have brought significant changes in the workforce participation of pregnant women and mothers. The extent to which varied employment experiences may contribute to known and growing problems with the quality of maternity care and troublesome trends in health costs and outcomes for mothers and babies is an urgent and important policy question, especially in light of current health reform efforts, stat and federal budget crises, and a national economic recession. The proposed project uses innovative methods to examine work during pregnancy as a key factor that may influence choices and health care use during childbirth, focusing on labor induction and cesarean delivery. Results from this study will provide input for the development and implementation of health care and employment policies designed to facilitate better childbirth care and improved maternal and child health.